NMOSI News:

SANTA FE — The New Mexico Office of Superintendent of Insurance cautions consumers who have subscribed, or are considering subscribing to health benefit plans offered by Health Care Sharing Ministries (HCSM) that these are not authorized health insurance plans.

A HCSM may use marketing practices that suggest its plans include the protections found in approved health insurance plans. However, that may not be correct.

These plans may be less expensive than a regulated major medical plan. They may also appear to provide the benefits and protections that a major medical plan is required to provide under the Affordable Care Act (“ACA”) and other health insurance regulations.

In reality, though, a HCSM plan is an unauthorized insurance product that likely will not provide the protections of an authorized, regulated, and ACA compliant major medical plan.

Consumers should be aware of the following regarding HCSM plans:

• They do NOT comply with the ACA, even if their materials say they do.
• Many HCSM plans specifically state that they do not guarantee payment for any health care and the member is ultimately responsible for anything the ministry does not pay. This important notification may be obscured or buried in fine print.
• They typically have restrictions or exclusions on pre-existing conditions, leaving the member uncovered and responsible for the health care costs for treatment of those conditions.
• Often such programs do not provide mental health coverage or substance use disorder treatment.
• Members may also be subject to religious or moral restrictions from the sharing ministry, which may leave members responsible for the full costs of health care that result from an activity the ministry does not agree with.
• Health care providers (doctors, hospitals) are under no obligation to accept or honor discounts from these programs if there is no contract or agreement to do so.

“I urge consumers not to purchase health insurance other than an ACA compliant plan. A consumer’s best source for individual and family health plan coverage is to shop affordable major medical coverage with your broker or agent or with BeWellNM.com. If you are outside of the open enrollment period, still contact BeWellNM.com or your broker or agent to see if you qualify for a special enrollment period.” Superintendent of Insurance Russell Toal said. “One of the first questions a consumer should ask before buying insurance from an agent or broker is whether they and the company they are recommending are licensed with the state of New Mexico and what their license numbers are. Licensed agents and brokers should readily provide this information to consumers. If they don’t, it should be a cause for concern.”

Consumers who are unsure what kind of coverage they currently have, whether it’s traditional health insurance, a health care sharing ministry plan, or something else, may contact OSI to find out what questions to ask. Contact Viara Ianakieva by email at viara.ianakieva@state.nm.us or by telephone at (505).827.4651.

The Superintendent of Insurance is taking action to protect consumers from unauthorized HCSM.

Today, OSI issued an Order to Cease and Desist and to Impose Penalties against a HCSM operating in New Mexico. Any person with questions regarding the Cease and Desist Order may contact Rebecca Branch, Assistant Staff Counsel, at rebecca.branch@state.nm.us or (505).827.4535.

If a consumer has any problems with a health care sharing ministry, or believes they’ve been deliberately misled by one of these entities, please contact OSI to let the agency know and find out about any available assistance. Any person with such a complaint should contact OSI at 1.855.427.5674 or https://www.osi.state.nm.us/index.php/contact-us/.